Limp is an abnormal gait and can result from congenital, infectious, inflammatory, traumatic, neoplastic or congenital causes. It can primarily involve the spine, hips/pelvis, abdomen, or musculoskeletal and soft tissues. Certainly you should start with an appropriately thorough H&P. Make sure to ask about: Fever and other symptoms associated with infections Trauma Systemic symptoms (pale skin, fatigue, easy/abnormal bruising and/or [...]
Most of the readers of this blog will have diagnosed at least one case of otitis media. If you haven't then you're not working enough (kidding). You may also have had discussions with parents of children presenting with ear pain (usually at 2AM) about how their child's TM doesn't look like an ear infection right now and that it could look like one in [...]
For those of you that have been following the blog over the past week you've been inundated with a series of posts on bronchiolitis - the most common lower respirator tract infection in infants - that just happens to be taking the country by storm. If you missed any part of the series you can check out the individual posts here. [...]
Alas, this is the final post in the bronchiolitis series. I hope you've enjoyed it. Parts I, II, III, IV, V, VI, and VII aren't going anywhere - so check them out if you haven't done so yet. This post will focus on the disposition of patients with bronchiolitis in the ED. Essentially, who do we feel comfortable sending home (and vice versa)? Let's take a [...]
Welcome back to the seemingly endless spew of bronchiolitis related content here on the PEM Blog. Check out editions I, II, III, IV, V, and VI if you'd like. Today we'll be focusing on additional modes of respiratory support in babies with bronchiolitis. So, without further ado let's get to it. Ask yourself the following questions before moving on. Do I use this therapy at my institution? If [...]
If you haven't read parts I, II, III, IV or V what are you waiting for? Today's post will focus on testing in bronchiolitis. And no, I won't be testing you... Let's get straight to the content. [divider scroll_text=""] Question: Do you need to get a chest X-Ray? Answer: No Consider the findings of Schuch et al in Pediatrics, 2007. [...]
Parts I through IV are in the books, so let's move onto another therapy that has been tossed around as a potential solution to bronchiolitis - Corticosteroids. In the early 'aughts many of you may have given steroids to bronchiolitics, but now you don't. Perhaps it will help if I frame things as A Tale of Three Studies. Disclaimer: Yes, I know that [...]
Parts I, II, and III are still there for those of you yet to dive in but now we turn our attention to a lesser used, but potentially valuable therapy in bronchiolitis. ED providers are already familiar with its use in the management of elevated intracranial pressure. What is it? Nebulized hypertonic (3%) saline of course. It is thought to increase [...]
Though a meta-analysis shows that racemic epi may help on the initial visit, the AAP recommended that it not be used as a trial therapy for most outpatient providers in its latest clinical practice guideline. You'll see that my original post and recommendation aligns with what the AAP says. Welcome to part 3 of the bronchiolitis series. Parts 1 and 2 are [...]
Though meta-analyses and systematic reviews - see below - have shown that beta agonists may improve symptoms scores they certainly don't affect disease resolution. Thus, since clinical scores are subjective and don't necessarily correlate with objective measurements. When sensitivity analysis is used to weed out weaker studies any effects towards benefit in the meta analyses is mitigated. Thus, the AAP [...]
